Post-pancreaticoduodenectomy hemorrhage: DSA diagnosis and endovascular treatment
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Tan-Yang Zhou1,2, Jun-Hui Sun1,2, Yue-Lin Zhang1,2, Guan-Hui Zhou1,2, Chun-Hui Nie1,2, Tong-Yin Zhu1,2, Sheng-Qun Chen1,2, Bao-Quan Wang1,2, Wei-Lin Wang1,2 and Shu-Sen Zheng1,2
1Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Zhejiang Province, Hangzhou 310003, China
2Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, 310003, China
Jun-Hui Sun, email: [email protected]
Keywords: pancreatoduodenectomy, postoperative hemorrhage, selective angiography, arterial embolism, treatment
Received: October 02, 2016 Accepted: April 14, 2017 Published: April 27, 2017
Objective: To explore the diagnostic value of digital subtraction angiography (DSA) and the effectiveness of endovascular treatment for a post-pancreaticoduodenectomy hemorrhage (PPH).
Results: During the DSA examination, positive results were found in 29 patients, yielding a positive rate of 69.0%. The manifestations of the DSA examination included contrast medium extravasation, pseudoaneurysm, and artery walls coarse. All 29 patients with positive results underwent endovascular treatment, including transartery embolization (TAE) in 28 patients and covered stents placement in one patient. The technical success and clinical success rates were 100% and 72.4%, respectively. Re-bleeding occurred in 8 of the 29 patients after the first treatment (27.6%). The mortality of PPH was 17.2% (5 of 29). Two of the five PPH patients died following severe infections, and three died from multiple organ failure.
Materials and Methods: A DSA examination was conducted using clinical and imaging data of 42 patients, and endovascular treatment for delayed PPH was retrospectively analyzed.
Conclusions: DSA examination is a minimally invasive and rapid method for the diagnosis of delayed PPH. For patients with positive DSA results, endovascular treatment can be performed rapidly, safely, and effectively. Therefore, the DSA examination and endovascular treatment could be considered a preferred treatment approach for delayed PPH.
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